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HIM Leaders Identify ROI Priorities and Strategies

By Angela Rose, MHA, RHIA, CPHS, FAHIMA

Release of information (ROI), also termed PHI [protected health information] disclosure management, has been and will continue to be a fundamental HIM function. We’ve upheld dominion of ROI through decades of organizational centralization, mergers and acquisitions, and payer audit and review programs.

However, with added pressures for greater efficiency and accuracy, new requirements for the ROI function have emerged, leading many HIM departments to reevaluate their priorities, strategies, staffing, and budgets. These include the following:

• larger volumes of government and commercial payer audits;

• increased risks for privacy and security breaches; and

• greater sensitivity and demand for patient satisfaction and their rights to PHI under HIPAA.

To understand how HIM leaders are balancing these multiple challenges, MRO commissioned a national survey by Porter Research, an independent market intelligence and research group focused on HIT. The findings provide valuable perspectives for HIM departments to consider and assess as they move into the 2020 budget and planning season. Below are three key areas to know.

Triggers for a New ROI Strategy
When is it time for an organization to reevaluate its ROI strategy? This was one of the first questions asked by Porter Research. Responses fell into two distinct categories: dissatisfaction with the current vendor and the need to standardize the ROI process across multiple locations and for the enterprise.

Inadequate quality, poor service, and breach occurrences were the three most common reasons for HIM’s discontent with an ROI vendor.

The second trigger for strategic change was the need to standardize and centralize PHI disclosure management on a single EMR through one outsourced ROI vendor to support an enterprisewide ROI department. Single, enterprisewide business departments have become commonplace as health care organizations continue to expand through mergers and acquisitions. This includes traditional HIM functions such as medical record coding, clinical documentation improvement, and disclosure management.

Attributes of a Successful Partnership
Whether survey participants were undergoing a major transition or simply considering a change, respondents identified the following important characteristics to assess during the evaluation process:

• ease of use: user-friendly and dependable system;

• workflow: efficient and effective workflows to ensure timely and accurate disclosures;

• turnaround time: all applicable timeline requirements are met (if not sooner);

• industry reputation: customer satisfaction, company integrity and values, and staff credibility; and

• ability to handle volume: request volume can fluctuate dependent upon time of year; quality service should not be impacted because of it.

Most partner evaluations included three or more ROI vendors initially, with two vendors making the short list for final vetting. The survey also identified key stakeholders for HIM professionals to include in the vendor evaluation process and noted that 57% of respondents considered themselves to be the final decision maker for ROI services.

Key stakeholders included the following:

• CFO
• CEO
• privacy/legal/HIM/compliance
• medical records director/manager/supervisor
• corporate manager of ROI
• corporate director of health information services
• corporate director of integration
• supply chain director
• contract and reimbursement
• vice president of finance
• vice president of revenue cycle

Readiness for New Requirements
Once initial attributes were assessed, Porter Research asked survey participants to rank specific capabilities that should be included in ROI partner contracts to ensure organizational readiness for the new ROI and PHI disclosure management pressures mentioned above.

Ranked in order of importance, these included integration and technical features, compliance, and level of service engagement. Price was the least important attribute when considering an ROI vendor.

These four requirements can be used by HIM professionals looking to transition from an in-house to an outsourced ROI model or seeking to replace their current vendor.

Integration and technical capabilities were especially noted as foundational requirements to advance accuracy and efficiency amid ROI centralization, volume increases, and rising breach concerns. These included optical character recognition throughout the quality assurance process to correct comingled records and the need for full integration between ROI vendors’ systems and release modules within the top-ranked EMRs.

Moments That Matter to HIM
Given the results of Porter Research’s survey, ROI partner capabilities to support an enterprisewide approach to PHI disclosure management are a must-have. Needs are becoming more complex, and vendors must address the intricate requirements of every organization. Now is the time to compare, contrast, and consider your ROI strategy.

Another important industry resource for HIM professionals with oversight of the disclosure management function is KLAS, a research firm that rates health care services and technology vendors. KLAS reports can be used as a trusted comparison tool. Each year, the firm releases a Best in KLAS report that shows how vendor performance scores stack up.

KLAS also releases targeted performance reports. Two reports for HIM to note are “HIM Services Performance 2015: Coding, Transcription, Release of Information” and “Release of Information 2018: Who Delivers Most Consistently Across Customers?,” which are available to health care provider organizations on the KLAS website.

There is a lot riding on HIM’s expertise in ROI: patient privacy, payer reimbursement, and a patient’s ability to share and receive their PHI. There are many ROI outsourcing choices available; choosing the one that meets continuously changing ROI demands while delivering compliant quality service is paramount.

— Angela Rose, MHA, RHIA, CPHS, FAHIMA, is the vice president of implementation services for MRO. She has more than 20 years of experience in HIM, with focused expertise on privacy, security, and ROI. She can be reached at arose@mrocorp.com.

Legal disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect or represent the views, opinions, or policies of MRO Corporation.